目的 研究仙鹿芪葛汤联合调督针刺疗法对颈椎间盘突出症（CIDS）症状改善及血清磷酸化-P38丝裂原活化蛋白激酶（p-P38MAPK）水平的影响。方法 选取2016年4月-2018年9月河南省中医院收治的156例CIDS患者，简单随机化法分为两组，各78例，对照组给予常规西医治疗，试验组给予仙鹿芪葛汤联合调督针刺疗法，比较两组总有效率、治疗前后田中靖久颈椎病症状量表20分法评分、血清免疫炎症因子[免疫球蛋白G（IgG）、IgA、IgM、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、IL-1]、p-P38MAPK通路蛋白表达[血管内皮生长因子（VEGF）、基质金属蛋白酶-3（MMP-3）、p-P38MAPK、MMP-9]、血清疼痛介质[一氧化氮（NO）、5-羟色胺（5-HT）、前列腺素E₂（PEG₂）]水平。结果 试验组总有效率94.87%高于对照组76.92%（P<0.001）；两组治疗后症状、体征、工作和生活能力、手功能评分高于治疗前，疼痛评分低于治疗前（P<0.05）；治疗后试验组症状、体征、工作和生活能力、手功能评分高于对照组，疼痛评分低于对照组（P<0.001）；两组治疗后IgG、IgA、IgM、TNF-α、IL-1、IL-6水平均低于治疗前（P<0.001）；治疗后试验组IgG、IgA、IgM、TNF-α、IL-1、IL-6水平低于对照组（P<0.001）；两组治疗后VEGF水平均低于治疗前，MMP-3、p-P38MAPK、MMP-9水平均高于治疗前（P<0.001）；治疗后试验组VEGF低于对照组，MMP-3、p-P38MAPK、MMP-9水平高于对照组（P<0.001）；两组治疗后NO、PEG₂、5-HT水平低于治疗前（P<0.05）；治疗后试验组NO、PEG₂、5-HT低于对照组（P<0.05）。结论 仙鹿芪葛汤联合调督针刺疗法治疗CIDS，能减少血清疼痛介质释放，明显改善患者疼痛等临床症状，抑制机体炎症反应，疗效显著，其机制可能与调控p-P38MAPK信号通路有关。

Objective To study the effects of Xianlu Qige Decoction combined with acupuncture on the improvement of cervical intervertebral disc symptoms (CIDS) and serum phosphorylation-P38 mitogen-activated protein kinase (p-P38MAPK). Methods A total of 156 patients with CIDS admitted to our hospital from April 2016 to September 2018 were enrolled. The patients were randomly divided into two groups, 78 cases for each. The control group was given conventional Western medicine treatment. The observation group was given the combination of Xianlu Qige Decoction and acupuncture. The acupuncture therapy was supervised, by comparing the total effective rate of the two groups before and after treatment. The Tianzhong Jingjiu cervical spondylosis symptom scale 20 points score, serum immunoinflammatory factors[immunoglobulin G (IgG), IgA, IgM, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-1, p-P38 MAPK pathway protein expression[vascular endothelial growth factor (VEGF), matrix metalloproteinase-3 (MMP-3), p-P38MAPK, MMP-9], serum pain medium[nitrogen monoxide (NO), serotonin (5-HT), and prostaglandin E₂ (PEG₂)] levels were compared. Results The total effective rate of the experimental group was 94.87% higher than that of the control group of 76.92% (P < 0.001). After treatment the scores of symptoms, signs, work and life ability and hand function of the two groups were higher than those before treatment, and the scores of pain were lower than those before treatment (P < 0.05). After treatment, the scores of symptoms, signs, work and life ability and hand function in the experimental group were higher than those in the control group, and the scores of pain were lower than those in the control group (P < 0.001); the levels of IgG, IgA, IgM, TNF-α, IL-1 and IL-6 in the two groups were lower than those before treatment (P < 0.001); the levels of IgG, IgA, IgM, TNF-α, IL-1 and IL-6 in the experimental group were lower than those in the control group (P < 0.001). After treatment, the levels of vascular endothelial growth factor (VEGF) in both groups were lower than those before treatment, and the levels of MMP-3, p-P38MAPK and MMP-9 were higher than those before treatment (P < 0.001); after treatment, the levels of VEGF in the experimental group were lower than those in the control group, and the levels of MMP-3, p-P38MAPK and MMP-9 were higher than those in the control group (P < 0.001). After treatment, the levels of NO, PEG₂ and 5-HT in the two groups were lower than those before treatment (P < 0.05); After treatment, the levels of NO, PEG₂ and 5-HT in the experimental group were lower than those in the control group (P < 0.05). Conclusion Xianlu Qige Decoction combined with acupuncture in the treatment of CIDS can reduce the release of serum pain media, significantly improve the clinical symptoms such as pain, and inhibit the inflammatory response of body, and its curative effect is significant. The mechanism may be related to the regulation of p-P38MAPK signaling pathway.

R287.21

中国医学气功学会资助基金项目（YXQG2015005）